Paul
Goble
Staunton, June 27 – Because of
Vladimir Putin’s health care “optimization” campaign – a euphemism for cutbacks
– only 45,000 of 130,000 rural population centers in the Russian Federation
have any medical services, and a combination of bad roads and poor
transportation services means that many who don’t have them can’t go to where
such services exist.
As a result, as Anatoly Komrakov reports
in “Nezavisimaya gazeta” today, “the level of mortality in rural areas is
significantly higher than in the cities” and Tatyana Golikova, the head of the
Accounting Chamber, is expressing concern that “there will be a rise in
mortality in rural areas” when statistics are published next month (ng.ru/politics/2016-06-27/1_selo.html).
Along with flight to the cities,
increased mortality in rural areas, now 1.8 per thousand greater in rural areas
than in urban ones, is pushing down the population in many parts of the countries.
While the population of Russian cities grew last year by 93,400, that of the
rural portions of the country fell by 61,400.
The situation in some regions is
especially dire, although no current statistics are available. Officials
promise to release them in August, Komrakov says. But despite their absence, data from some
regions are available already – and they indicate that the collapse in health
care in rural areas is behind the rise in mortality rates there.
In Orel oblast, one of the most
ethnically Russian regions of the country, health care has collapsed over the
last 25 years. In 1990, there were 12,700 hospital beds for rural residents; in
2000, there were 10,500; now there are only 7500. The number of polyclinics has
fallen over the same period from 133 to 85 and the number of nurses by 13
percent.
As a result, the “Nezavisimaya
gazeta” journalist reports, “if 25 years ago, morality in the oblast stood at
13 deaths per 1,000 residents; in 2015, the rate stood at 16.4 per 1,000, an
increase of 26.4 percent.” The situation in Pskov oblast is even worse, and as
a result, life expectancies there are five years less than for Russia as a
whole.
According to Eduard Gavrilov,
director of a health monitoring foundation, there are today “three to four times”
fewer doctors in rural areas than in cities and mortality rates in rural areas
are “15 to 18 percent higher.” And
because there are fewer doctors, fewer people are able to visit them: the
number of rural people seeing a doctor fell by 39 million between 2012 and
2015.
Figures for infant mortality also
vary widely between rural areas and the cities, according to government
statistics, and mortality among women giving birth is much higher in rural
areas than in urban ones: In Stavropol kray, 13.6 such women out of a thousand in
rural areas are die in childbirth while in cities only 8.9 per thousand do.
The real figures for rural Russia
are almost certainly worse than what the government is reporting, Komrakov
says, for two reasons. On the one hand, some officials have ordered hospitals
not to report more than a certain number of deaths each month regardless of how
many there actually are. (See permv.ru/2016/06/22/prikamskiy-minzdrav-vvel-kvoty-na-kol/.)
And on the other, in an additional cost-saving
measure, doctors rather than anyone else are responsible for reporting deaths
to government statisticians. In the two-thirds of Russian villages where there
are no doctors any more, there is no one left to report on deaths and so they
are unlikely to be included in Russian government statistics.
Впрочем, по данным Татьяны Голиковой, в 85 тыс. населенных пунктах страны за подобной статистикой вообще никто не следит, так как там нет никаких форм оказания медицинской помощи.
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